EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update

Annals of the Rheumatic Diseases - Tập 79 Số 6 - Trang 685-699 - 2020
Josef S Smolen1, Robert Landewé2,3, J. W. J. Bijlsma4, Gerd R Burmester5,6, Maxime Dougados7, Andreas Kerschbaumer1, Iain B. McInnes8, Alexandre Sepriano9, Ronald van Vollenhoven10,11, Maarten de Wit12,13, Daniel Aletaha1, Martin Aringer14, Johan Askling15, Alejandro Balsa16, Maarten Boers17, Alfons A den Broeder10,18, Maya H Buch19,20, Frank Buttgereit5,6, Roberto Caporali21,22, Myrna Cardiel23, Diederik De Cock24,25, Cătălin Codreanu26, Maurizio Cutolo27, Christopher J Edwards28, Yvonne van Eijk‐Hustings29, Paul Emery30, Axel Finckh31,32, Laure Gossec33, Jacques‐Eric Gottenberg34, Merete Lund Hetland35, T. Huizinga10,36, Marios Koloumas37,38, Zhanguo Li39, Xavier Mariette40, Ulf Müller‐Ladner41, Eduardo Mysler42, José António Pereira da Silva43, Gyula Poór44, Janet Pope45, Andrea Rubbert‐Roth46, Adeline Ruyssen‐Witrand47, Kenneth G. Saag48,49, Anja Strangfeld50, Tsutomu Takeuchi51,52, Marieke Voshaar53,54, René Westhovens24,25, Désirée van der Heijde10,36
1Division of Rheumatology, Department of Medicine 3, Medical University of Vienna
2Amsterdam University Medical Center
3Zuyderland Medical Center
4Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht
5Charité - University Medicine Berlin, Free University and Humboldt University Berlin
6Department of Rheumatology and Clinical Immunology
7Rhumatologie B, Hopital Cochin, 27 rue du Fbg Saint-Jacques
8Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow
9NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal, and Department of Rheumatology, Leiden University Medical Center
10Department of Rheumatology
11VU university medical center;
12Department Medical Humanities, Amsterdam University Medical Center
13EULAR Patient Research Partner
14Division of Rheumatology, Department of Medicine III, University Medical Center and Faculty of Medicine Carl Gustav Carus
15Department of Rheumatology, Karolinska University Hospital
16Servicio de Reumatologia Hospital Universitario La Paz, Instituto de Investigacion IdiPAZ
17Department of Epidemiology and Biostatistics and Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam
18Sint Maartenskliniek
19Division of Musculoskeletal and Dermatological Sciences, University of Manchester
20NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust
21Department of Clinical Sciences and Community Health
22University of Milan, and IRCCS S Matteo Foundation
23Centro de Investigación Clínica de Morelia SC
24Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven
25Rheumatology, University Hospitals Leuven
26Center of Rheumatic Diseases, University of Medicine and Pharmacy
27Research Laboratory and Division of Clinical Rheumatology, Department of Internal Medicine - University of Genoa
28Musculoskeletal Research Unit, NIHR Clinical Research Facility, University Hospital Southampton
29Department of Patient & Care and Department of Rheumatology, University of Maastricht
30NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
31Division of Rheumatology
32University Hospitals of Geneva
33Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris and Pitié Salpêtrière hospital, AP-HP, Rheumatology Department
34Strasbourg University Hospital and University of Strasbourg, CNRS, Institut de Biologie Moléculaire et Cellulaire, Immunopathologie, et Chimie Thérapeutique
35Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen
36LEIDEN UNIVERSITY (MEDICAL CENTER)
37Cyprus League against Rheumatism
38European League Against Rheumatism
39Department of Rheumatology and Immunology, Beijing University People's Hospital
40Université Paris-Sud, AP-HP, Université Paris-Saclay
41Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig University Giessen
42Organización Médica de Investigación
43Serviço de Reumatologia, Centro Hospitalar e Universitário de Coimbra Praceta Mota Pinto, and Coimbra Institute for Clinical and Biomedical Research (i-CRB), Faculty of Medicine of Coimbra
44National Institute of Rheumatology & Physiology, Semmelweis University
45University of Western Ontario, Schulich School of Medicine & Dentistry, Department of Medicine
46Klinik für Rheumatologie, Kantonsspital St Gallen
47UMR 1027, Inserm, Université Paul Sabatier Toulouse III
48Department of Medicine, Division of Rheumatology
49University of Alabama at Birmingham
50Programme Area Epidemiology, Deutsches Rheumaforschungszentrum Berlin
51Keio University Hospital
52 Keio University, School of Medicine
53Department of Psychology, Health and Technology
54University of Twente,

Tóm tắt

ObjectivesTo provide an update of the European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) management recommendations to account for the most recent developments in the field.MethodsAn international task force considered new evidence supporting or contradicting previous recommendations and novel therapies and strategic insights based on two systematic literature searches on efficacy and safety of disease-modifying antirheumatic drugs (DMARDs) since the last update (2016) until 2019. A predefined voting process was applied, current levels of evidence and strengths of recommendation were assigned and participants ultimately voted independently on their level of agreement with each of the items.ResultsThe task force agreed on 5 overarching principles and 12 recommendations concerning use of conventional synthetic (cs) DMARDs (methotrexate (MTX), leflunomide, sulfasalazine); glucocorticoids (GCs); biological (b) DMARDs (tumour necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), abatacept, rituximab, tocilizumab, sarilumab and biosimilar (bs) DMARDs) and targeted synthetic (ts) DMARDs (the Janus kinase (JAK) inhibitors tofacitinib, baricitinib, filgotinib, upadacitinib). Guidance on monotherapy, combination therapy, treatment strategies (treat-to-target) and tapering on sustained clinical remission is provided. Cost and sequencing of b/tsDMARDs are addressed. Initially, MTX plus GCs and upon insufficient response to this therapy within 3 to 6 months, stratification according to risk factors is recommended. With poor prognostic factors (presence of autoantibodies, high disease activity, early erosions or failure of two csDMARDs), any bDMARD or JAK inhibitor should be added to the csDMARD. If this fails, any other bDMARD (from another or the same class) or tsDMARD is recommended. On sustained remission, DMARDs may be tapered, but not be stopped. Levels of evidence and levels of agreement were mostly high.ConclusionsThese updated EULAR recommendations provide consensus on the management of RA with respect to benefit, safety, preferences and cost.

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Annals of the Rheumatic Diseases

Tập 79 Số 6

685-699

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